Bloodwork and other Labwork

The following are real issues related to Bloodwork and other Labwork in Dogs that have been treated by Dr. Mike Richards, DVM.

Creatine phosphokinase (CPK) or creatinine kinase (CK) value elevations
Causes of Low Amylase and Low Albumin
Increased ALT Levels in a Dog
Rise in White Cell Count
Reasons for High BUN Level
High Levels of Calcium - Hypercalcemia
Lab work - Hematocrit (HCT)
High Globulin Count (hyperglobulinemia), Seizures and Lethergy
Causes of Increased Platelet Count
Evaluating Lipase Levels Following Pancreatitis
Elevated Amylase Levels, Pancreatitis and Bladder Problems
High Potassium Levels with Diarrhea
Reasons for High Cholesterol Levels in Dog Serum

Creatine Phosphokinase (CPK) or Creatinine Kinase (CK) Value Elevations

Question:

Blue, 3 years old border collie, had a blood test today and a week ago. All his blood results were normal except the creatine enzyme which was a little high. Urea was normal. A urine sample was taken and that was normal. Vet thought there was nothing to worry about. She said it was probably normal for Blue's creatine levels to be a little high because he is a muscular dog. He eats Hill's t/d. Just thought I would let you know and ask for any comments. 

Answer:

I am assuming that this is the creatine phosphokinase (CPK) or creatinine kinase (CK) value. If this is the case, the most common causes of rises in CK are muscle disorders. If there is no evidence of a muscle disorder, I don't see a reason to worry about one being present. Other possible causes are exertional hyperthermia (technically a muscle disorder, as well), hypothyroidism, heart disease, recent exercise prior to the blood test, selenium/Vitamin E deficiencies and trauma to the muscles. Unless I had some reason to suspect one of these other disorders I think that I would tend to agree with your vet that a slight rise in CK levels is not a good reason to go looking for an inapparent problem. You can always recheck the levels if a problem does seem likely, or even just as a precaution at a future time. 

Causes of Low Amylase and Low Albumin

Question:

What are the main causes for LOW Amylase (651) and LOW Albumin (2.55) levels?

Answer:

There are no known physiologically significant causes of either low amylase or low lipase levels. If clinical symptoms indicate that there is a lack of production of pancreatic enzymes (diarrhea, weight loss) then testing for trypsin-like immunoreactivity (TLI test) is the best diagnostic test for pancreatic insufficiency. If there are no clinical signs suggestive of a problem it should be safe to ignore these lab values. 

Increased ALT Levels in a Dog

Question:

My question concerns elevated levels of ALT in my almost 6 year old male Golden Retriever. In August of 1999, I had blood drawn for a standard chemistry panel and blood counts so we would have a set of baseline values. All the results were within the normal ranges for chemistry and CBC. His T4 level was 1.8 which is low normal and he ws started on 0.4mg Soloxine once a day. On November 29 2000, we repeated the blood chemistry and CBC. This time, the ALT was 164, with the normal range for the test lab being 5 - 60 IU/L. The remainder of the tests were within the normal ranges, including others that are less specific for the liver AP =39, AST = 23, GGT = 6. The T4 level was 1.1. The ALT was repeated on December 19 and had increased to 254. The lab ran a bile acid assay on the same sample next day and it was normal (6.9 with 20 or less being normal). On December 28, the blood chemisty panel and CBC were repeated, along with ammonia and sorbitol dehydrogenase. I realize SDH is more typically used for horses than dogs, but I asked for it and the ammonia as additional ways to look for liver damage. The ALT was 89 which is lower but still out of the normal range, while SDH (7.7, range 2.9 -8.2 ) and ammonia (33 range 20 -120) were both within normal range. The dog appears healthy, and is a very energetic athletic dog. Without the blood work there is no way you would suspect that anything was wrong with his health. He runs hard every 2 or 3 days retrieving bumpers and birds as part of his field training and other days goes for daily runs around our pastures. The only thing that changed prior to the November blood test this year was that he had been off the soloxine supplement for about 2 weeks. Do you have any suggestions as to what would cause an increse in ALT without affecting other liver enzymes or liver function? Are the levels high enough to be really concerned? The thing that bothered me the most was the increase form164 to 254 in less than 3 weeks. Could the low T4 levels be related (either cause or effect) to the changes in ALT? Any light you can shed on this will be very welcome. We are going to redo the liver enzymes in about 3 weeks to see where they are going. 

Answer:

It is not too unusual to have rises in ALT levels that are found in a blood sample taken for reasons other than suspicion of liver disease and then for these levels to resolve over several weeks to several months. ALT rises when liver cells are damaged and lots of things can lead to enough damage to liver cells to increase the ALT levels. Many of these things never cause any clinical signs of liver disease nor measurable effect on liver function using bile acid or other liver function testing. In most cases we never know what happened, but drug reactions, trauma, bile stasis, blood clots and toxins are all possible explanations. If the ALT level continues to drop, it may not be possible to determine why it became elevated in the first place, but it wouldn't be too important to know, either. If there continues to be a slightly elevated ALT level over time, I think that I would be most concerned about the possibility of an idiosyncratic (unexplained) reaction to the thyroxine supplementation leading to the rise in ALT based on the timing of the increase in ALT. It seems reasonable to me to stop the thyroxine supplementation because there is a strong possibility that it is not necessary because total T4 levels are not a reliable way to determine if hypothyroidism is present. The most accurate test that I know of at the present time is a free T4 measurement done by equilibrium dialysis. Even if hypothyroidism is present, it would be unlikely to be harmful to stop thyroxine supplementation for a few weeks to see what happens. If the ALT dropped into normal ranges, I think I'd try for more accurate testing to see if supplementation is really necessary. If the ALT remained elevated you could chose to supplement or not based on clinical signs or other criteria you and your vet are comfortable with. If your vet feels strongly that stopping the dosage of thyroxine is a bad idea, it would probably be better to go with his or her opinion since physical exam findings may be playing an strong role in the diagnostic process. As long as there are no visible clinical signs of liver disease, I tend to do nothing in these cases except for monitoring the blood until the client and I believe that it is reasonable to stop doing that. Once in a while rises in ALT alone are the first sign of a more serious liver problem like chronic active hepatitis or copper storage disorders. Good luck with this. I hope the level continues to drop. 

Rise in White Cell Count

Question:

My dog Natty is a Border Collie/McNabb, eleven years old and weighs 67 pounds. In late September I asked our Vet. to check her blood just because she is getting older. The test showed her infection fighting cells were high and he put her on tetracycline, 3 pills 3 times a day. At the end of that time her blood was normal. Because a neighborhood dog, a year younger that Natty and a constant visitor at our house, unexpectedly died, I had her blood tested again, just for good measure. Again, the infection cells were high and again she is on tetracycline, same dosage and same length of time, 3 weeks. I is not yet time to retest her blood. What do you think could be causing this problem. She doesn't seem sick. She did seem to be a bit arthritic and I just got the medicine for that which has helped. She eats quality food and her appetite is fine. I live in a small town not close to a teaching University and I rely on my Vet for Natty and ten cats. This has him stumped. Can you offer us a reason and a plan of action if her test does not come back normal next week? Thank you for the invaluable help you offer all of us. 

Answer:

It would help a great deal in providing possible diagnoses if you could obtain the results of the complete blood cell counts that have been done so far. There are several types of white blood cells and the total count is not quite as meaningful as the rises in individual cell types. If there is a rise in neutrophils and no immature neutrophils are found in the blood, for instance, this can occur due to stress or Cushing's disease in the absence of an infectious process. If there is a rise in neutrophils with a concurrent rise in immature neutrophils, then an infection is much more likely. If the total white blood cell count is high due to a rise in neutrophils and eosinophils, then an allergic or parasitic process is most likely. Rises in lymphocytes can indicate cancer. There are other combinations of rises in individual cell types that can be meaningful, as well. So knowing what cells are high, what cells are low and combining that with the findings on a physical exam can help to determine what is happening. There are times when rises in white blood cell counts occur for no discernible reason and it can take some real detective work to figure out what the cause is. Even though you vet is stumped, right now, as symptoms and lab work change over time there may be a recognizable pattern or signs of a specific disorder may emerge. So keep working with your vet. I will be glad to provide a list of differential diagnoses (possible diagnoses) based on the lab work if you can send it. I am sorry for the delay in response to your question and I hope that Natty's is still doing well. 

Reasons for High BUN Level

Question:

My miniature schnauzer, Dublin (5 months old at the time), was in the vet's getting spaded and when they ran tests her BUN level was at 48. Her Bun/creatine ratio was 37, triglycerides 365,calcium 11.5 and phosphorous 6.6. All other levels were normal. The Vet was very concerned with the high BUN at her age. They tested for kidney function via urine tests and everything appeared fine. We had an ultrasound to look for any abnormalities with the kidney and again everything was normal. The vet put her on Hills KD and her BUN one month later was 20. She has gained weight and the vet suggested we switch her to Hills GD which was less fat. What do you recommend? She is still a bit overweight 19 lbs and I am concerned that she is missing critical nutrients being on a Hills GD diet at her age. Please let me know what you suggest and why such a small puppy would have such high BUN levels. 

Answer:

One of the problems with doing pre-anesthetic blood tests and other routine screening blood tests is that when an abnormality is found, there is a tendency to ignore a lot of other evidence that a pet is normal, in favor of either more invasive testing or therapeutic efforts to correct problems that may or may not exist. Elevations in BUN (blood urea nitrogen) of up to 50 mg/dl due to a recent high protein meal (according to "Small Animal Clinical Diagnosis by Laboratory Methods" by Willard, et. al.). Puppies often have elevated BUN levels due to high protein diets and can quickly develop rises in BUN due to dehydration, since they are more prone to this problem than adult dogs. Some pets just have an elevation in one lab value, that seems to be a consistent finding, that never causes problems during their lifetime. Since the urinalysis was normal and the creatinine normal (based on the BUN/Creatinine ratio) the odds are really high that there was nothing wrong with your puppy's kidneys. The use of Hill's k/d (tm) in a puppy is not recommended by the manufacturer as a routine thing but it doesn't appear to cause problems when it is used, based on anecdotal reports from several vets I have spoken with who have put puppies on this diet. I would assume that the same thing is true for g/d (tm) diet. Truthfully, I don't see much reason to worry about using any special diet for the sake of the kidneys with the lab values you are reporting, though. It wouldn't be a bad idea to recheck the cholesterol and triglyceride levels, though. Lipemia (high values of lipids like cholesterol and triglycerides in the blood) are a problem in some schnauzers and do seem to cause problems sometimes. Last week, I had a similar situation to what you are describing, except that I had an older cat in for a routine blood screening test in the practice with a high BUN and normal creatinine. I started explaining chronic renal failure and was heading down the road of initiating treatment when my wife (also a vet) pointed out that I was probably jumping the gun, since we had an apparently normal patient with normal creatinine and normal urine concentration. Of course, she was right. So we are going to recheck the lab values on the cat in a couple of weeks and then decide what to do. Hope this helps some. 

High levels of Calcium - Hypercalcemia

Question:

A few months ago, we returned to Vancouver to find our dog lethargic. I took her to our new vet who did a bloodtest. The result was hypercalcemia. The vet said it was most likely a cancer. I told him that my son had overdone the excercise while we were away, and she was likely suffering with arthritis. We changed her food to Medical geriatric formula. After another 2 bloodtests, her calcium was back to below normal. The vet put her onto Metacam indefinitely. Is this a good choice for arthritis?

Answer:

It is usually best when a blood test shows hypercalcemia to test the blood again before trying to make a diagnosis. I do not know about other labs, but ours has more trouble with calcium levels than with most other tests. It isn't too unusual for us to have a dog show high calcium levels on one test and then not on others. On the other hand, the most common causes of high calcium levels are serious illnesses, such as metastatic cancer, kidney failure and hyperparathyroidism. It is worth considering periodic monitoring for these problems if there is any indication of them in the rest of the blood work, though. Meloxicam (Metacam Rx) is not available in the United States but the information that I have seen on this medication seems to be in agreement that it is effective and reasonable to use long term. 

Lab Work - Hematocrit (HCT)

Question:

I am a subscriber and we have communicated about Kenya just recently. I just had my vet fax me the lab work and here are some observations: The lab indicates the normal range for lipase is 100-500 iu/l and her original level (July) was 593. Three weeks later on a restricted diet it dropped to 516. Your letter said the normal range is 0-160 iu/l. Needless to say, I am confused. What do you make of this discrepancy? Her amalyse level ("normal" = 500-1500) is 501. I was not aware previously that there were other abnormal readings. They are as follows: HGB 19.0 (norm=12-18) HCT 56 (norm=37-55) Eosinophil 1 (norm=2-10) Absolute Lymphocyte 945 (norm = 1000-4800) Absolute eosinophil 63 (norm=100-1250) Do you have any more ideas based on this labwork? Kenya is not vomiting to my knowledge, and yesterday I finally saw that two consecutive stools were without mucus. She's still a bit uncomfortable, as is evidenced by her wanting to cut walks short lately. She has gas as well. I got your message about the Pepcid, etc. and will try that. 

Answer:

It is really important to use the normal values for the lab that the samples are run at. They do sometimes vary from the "average" as much as the difference that this lab reports. I would not worry too much about this lipase level since it is within the range that dehydration or mild decreases in kidney function could cause and the amylase was not concurrently elevated but that is just my personal opinion. The hematocrit (HCT) is the percentage of the blood that is composed of red blood cells. When the percentage rises, it means there are more red blood cells or less liquid portion of the blood. The most common cause of rises in hematocrit is dehydration but disorders that cause decreases in oxygen transport can cause rises in hematocrit (like heart failure and respiratory disease) and it can occur due to abnormalities in production of red blood cells. But the most likely problem with this low a rise is dehydration. That would also be true for the rise in hemoglobin. The best way to be sure that the rise in hematocrit was due to dehydration is to retest at a time when Kenya is likely to be normally hydrated (when she seems to feel fine). I am not sure it is worth retesting if she is acting fine and doing fine, though. 

High Globulin Count (hyperglobulinemia), Seizures and Lethergy

Question:

I have a real stumper for you....... Last fall, our 13 year old Westie, Button, was acting lethargic so we visited our vet. A routine blood test turned up a high globulin count which our vet warned could be indicative of more serious problems (e.g. multiple myeloma). We agreed to additional blood work and urine tests all which came back suggestive of multiple myeloma. We were distraught and sought a second opinion from an iternal medicine specialist. X-rays were negative for bone lesions and a bone marrow sample turned out normal. The only tests we did not agree to were a CT scan of the head and obtaining a sample of CSF. During this time, a veterinary ophthalmologist noted tortuous vessels in the back of his left eye and that his pupillary response in that eye was absent. At this point we had a lethargic dog with symptoms that did not totally match multiple myeloma according to the internist. Feeling a sense of resignation, I indicated that the last time Button seemed to be "his old self" was when he was on antibiotics which were given early in the treatment of his lethargy. Indicating it couldn't hurt, Button started the maximum daily dose of clindamycin. Within 2 weeks, his activity returned to normal AND so did all of his bloodwork. We began to ween him off the clindamycin when he exhibited a "seizure" in early December. Also, his globulin count rose again. We went back up in our dose of clindamycin and the seizures stopped and the blood work normalized AGAIN. This spring the seizures started to increase in frequency despite the dose of clindamycin so phenobarbital was added to his dosing regimen. He has responded well to the phenobarbital and guess what, his bloodwork is abnormal again. A few more details.....the last 2 times the bloodwork has been abnormal he has also been anemic. There were no obvious signs of bleeding and he responded to the clindamycin. The seizures seem to be stimulated by excitement and are indicated by short "fainting" spells. He also pants quite a bit at rest even in an air conditioned home. We are told that there is no evidence of multiple myeloma symptoms appearing and then disappearing so that diagnosis seems to be shelved. Our vets openly admit that they are stumped. Also, an ultrasound of his belly indicated that there was no evidence of a splenic tumor and his ECG is normal. So....we continue with the phenobarb. and have increased the clindamycin dose to see if again his bloodwork will normalize. Button will be 14 in October and we have tried to maintain quality of life but continue to wonder if there is something else that we should consider. We would be deeply appreciative if you would comment on this case. 

Answer:

I can think of some disorders that would cause the symptoms you are seeing, but I am not at all sure that they are likely or even possible. Canine monocytic ehrlichiosis causes hyperglobulinemia (high globulin levels in the blood), lethargy, depression and bleeding tendencies. I have not seen seizures as a listed symptom for this problem. It is treated with doxycycline or imidocarb, usually, but might respond to other antibiotics. Any form of ehrlichiosis could cause problems. We see a lot of older dogs with dental disease that causes lethargy, depression and appears to be a source of high globulin levels (this is personal observation, not documented by any studies I am aware of). This is very responsive to antibiotic therapy but won't resolve unless the dental problems are identified and treated. We have not associated this problem with seizures, either, though. Systemic fungal infections will cause hyperglobulinemia but usually cause other clinical signs, like coughing, weight loss, inappetance, lameness or something that indicates a pretty serious problem. There is a report of anerobic bacterial infection of the central nervous system (Dow, 88) but the dogs affected by these bacteria died quickly. However, the signs seen in them did match what you are seeing -- lethargy, depression, seizures, as well as other symptoms, including paralysis and other severe CNS signs. Cancers sometimes cause increases in globulin levels and may cause almost any clinical symptom, depending on where they are located and what they effect. Finding cancers can be really difficult. It would be a little odd for antibiotic therapy to make a difference if cancer is the cause of the symptoms but sometimes antibiotics help for reasons other than their antibiotic actions. Heartworm disease will sometimes cause inceases in globulin levels in the serum and can cause the symptoms seen, although coughing is usually present by the time fainting spells that resemble seizures occur with this disease. Bacterial endocarditis might cause the depression, lethargy, seizure like activity and hyperglobulinemia and would be responsive to antibiotics. A heart murmur is often present with this problem. There are usually ECG signs associated with bacterial endocarditis but cardiac ultrasound is a better way to look for this problem. Chronic infections almost anywhere can cause increases in globulin levels and would respond to antibiotics. It seems like it would be easy to find an infection but there are lots of reports of infections in the urinary system, liver, gallbladder, spinal column and other areas of the body that didn't surface until extremely serious signs finally showed up or were found incidentally on post mortem exams. I don't know if any of these possible differentials will help. I wouldn't be at all worried about using clindamycin long term if it seemed to help. This is a fairly common approach to persistent periodontal disease in dogs so there is a lot of evidence to suggest it doesn't cause problems very often. Your vets probably thought of these and appear to have been working to rule most of them out. Keep working with them and hopefully some clinical sign that points the way to a diagnosis will appear soon.

Causes of Increased Platelet Count

Question:

I have a question regarding a High platelet count. I've seen several questions regarding low count but my Bichon Frise has the opposite problem. I adopted "George" from an animal rescue on July 5. Other than being a little shy he seemed OK. A vet in TX has just given him a physical and he was deemed healthy, free of disease and able to fly. On July 11, I took him to our local animal hospital here in Illinois. They also examined him, we've determined that he's about 7 years old, and at one time probably broke his shoulder blade. I took him back the next day, July 12, to get his teeth cleaned, major tartar. When they did the blood test, his white cell count was 33,000. The Dr. me said that it should be around 12,000. A couple of other "things" didn't look quite right so they did a full blood panel. George's platelet count came back extremely high. It registered at 3 million. The Dr. said it should be about 300K - 510K. A urinalysis did show that George has a UTI. He's currently on antibiotics, twice a day. They also put him on dewormer, even though blood and stool samples tested negative for worms/parasites. The white cell count could be attributed to the UTI, but not the platelet count according to the Dr. A pathologist looked at the results and thought maybe there was internal bleeding at one time. His potassium level, liver, kidney levels appeared to be normal, not alarming. George appears to be fine, he has a huge appetite and loves to go for walks twice a day. His red cell count has not changed from day to day, so it doesn't look like they are being destroyed. There is some speculation as to whether or not the marrow is releasing immature red cells. They did see some in a second blood test. I'm supposed to wait until this Friday, July 21, and take him back for another blood test. The Dr's at the clinic said they've never seen a platelet count this high. Do you have any idea what could be causing this, is it life threating? I look forward to your answer. 

Answer:

These are reported causes of increased platelet counts: hypothyroidism (usually fairly mild increases) essential thrombocythemia (reported in the Feb 99/March 99 Compendium of Continuing Education) - signs were lethargy, weight loss, depression This condition is also likely to cause an increased white blood cell count due to neutrophilia and anemia. myeloproliferative disorders (like excessive bone marrow stimulation, cancers of the bone marrow, metastatic cancers stimulating the bone marrow) platelet function abnormalities sometimes lead to increased platelet numbers as the body tries to compensate for the fact that the platelets don't work well (usually mild increases, though) iron deficiency and chronic blood loss (from any source - urinary tract, gastrointestinal tract) can lead to thrombocythemia With the great elevation in these values, essential thrombocythemia seems likely, even though George doesn't seem to have the clinical signs expected with that problem. Bone marrow analysis is helpful in differentiating among the causes of increased platelet counts. Your vets may have access to the Compendium article since a lot of vets subscribe to this journal. 

Evaluating Lipase Levels Following Pancreatitis

Question:

Here's the situation: My 11 year old German Shep. mix has been diagnosed with Pancreatitis; however, he really is just on the fringe of the condition. He's not in any pain, has no abdominal bloat, etc. but five weeks ago started with diarrhea, which had small flecks of blood in it. Then, he had one instance of vomiting. We tried to regulate his condition through diet (fasting, initially), fluids, and Gastriplex, which is made by Thorne Research and not a "white man drug". The Gastriplex seemed to upset his stomach - he was very, very restless. For the first couple of weeks, we were unable to control the diarrhea, but the vomiting stopped. Bloodwork and x-rays revealed nothing remarkable, except an elevated lipase level. I began feeding him brown rice with a little garlic butter and eventually added a few veggies. The diarrhea was coming under control, but not the lipase level. We added some very small amounts of cooked chicken to the rice and the diarrhea started again. So, off food, on fluids we went and again, the lipase shot up. It had come down to within normal range only once and after going on chicken, it shot up again. I started feeding him again and two weeks ago began feeding him chicken baby food with the rice. His poops hardened up and were formed within several days and his lipase was on directly on the line dividing "normal" and "high". For two weeks we did this and my vet (another vet in the practice put him on the baby food because my vet was on vacation) didn't like the consistency of his stool - oatmealy and orange. He took him off the baby food and put him on rice and small amounts of turkey and veggies late last week and put him on Gastrigen (another Thorne product). Friday night, Storm (the dog) was up ALL NIGHT, panting, pacing, etc. and did not settle down Saturday morning. I called Dr. Strong, we went in and put him on fluids and took another blood sample. His lipase was in the middle range of the "high" level. So, we started the fast again and I took him in for fluids on Sunday. Today he had an ultrasound, which revealed a slightly swollen pancreas, nothing alarming to my vet, but of more concern were the "spots" on one side of his liver. Not of tumor size, but obviously a concern. He's still fasting and we go in tomorrow for fluids. Then, another lipase test on Wednesday. My vet is getting more concerned now because we can't get the lipase to within normal range. My vet and I both agree Storm is on the fringe of pancreatitis - not really displaying hard and fast symptoms, but the lipase and spotty liver is obviously an issue. He is happy, eating well (when he's allowed!), and generally seems to be fine on the outside. I've had him 9.5 years and I know he's feeling fine. Dr. Strong feels he's a ticking time bomb, unless we get this lipase level regulated. Certainly, we would like to fix this before it becomes a crisis. Do you have any thoughts, suggestions, experience, etc. with elevated and stubborn lipase levels? I would greatly appreciate your input and am very happy to compensate you for your time and expertise above the subscription fee. Thank you so very much in advance for your feedback. 

Answer:

Lipase becomes elevated most commonly due to pancreatitis or a decrease in kidney function. The decreases in kidney function can occur due to causes other than the kidney itself. The kidney is dependent on adequate blood flow and blood pressure to work, so dehydration and low blood pressure can cause a decrease in kidney function. Kidney diseases or obstructions to urine outflow from the kidney are the other conditions that can lead to increases in lipase or amylase levels due to kidney disease. It is also possible for intestinal conditions such as inflammatory bowel disease (IBD) to cause rises in lipase or amylase levels sometimes. Pancreatitis can cause rises in lipase and amylase to three or more times the normal level, with increases as much as ten to fifteen times normal occurring in some cases. Kidney disease usually causes rises to about fifty percent of normal and smaller rises tend to occur with IBD. It is usually best to try to evaluate lipase and amylase levels together, since they should both rise when pancreatitis is present. Unfortunately, both may rise with the other conditions listed above, as well. At this point, it doesn't seem to me that there is enough evidence to be sure of what is going on. Pancreatitis is definitely a condition that should be in the list of differentials and it may be the problem, but it doesn't seem that this is a certainty to me, yet. I would probably want to look for evidence of a decrease in pancreatic function by checking for trypsin-like immunoreactivity (TLI) in the serum (this is a test many commercial labs can arrange for) as a way of checking on pancreatic function. A decrease in pancreatic function could produce the clinical signs that you are seeing, although it would be a little unusual to have increases in lipase levels and decreases in TLI levels. It may be worthwhile to ask your vet to refer you to an internal medicine specialist for a second opinion. One thing that bothers me, though, is that you are worried about a lab value when the clinical signs of illness do not seem to be present at this time. It is important to place more emphasis on the patient's signs than the lab values when a conflict like this occurs, in most cases. The lab values are important and if it is possible to clarify their meaning without endangering the patient it is a good idea to do that but keep your shepherds' overall condition in mind and try to remember to diagnose and treat based on the whole patient and the whole clinical picture, not just one lab value. Hope this helps some. 

Elevated Amylase Levels, Pancreatitis and Bladder Problems

Question:

I have an eight year old schipperke. He had a urethrostomy for urolithiasis about one year ago. He has been on the C/D diet (carrots for treats) and doing quite well except for the occasional need for antibiotics to treat blood in the urine. I was told he would be prone to these infections now. About two weeks ago he was put on another round of antibiotics and the S/D diet because there was blood and crystals in the urine. Last Wednesday (5/3) he suddenly became very ill. He was vomiting, hunching his back in pain, and looked bloated. I took him to the emergency room and he was diagnosed with pancreatitis. They kept him overnight to start IV fluids and when I picked him up the next day he appeared much better. My regular vet kept him until Saturday. When he went to the emergency room his amylase was almost 16,000 and it was still over 13,000 when my vet checked him a couple days later. He never had a fever and all his other lab work including WBC have been normal. When he was staying at the vet he did not vomit but when I got him home he vomited bile about 12 hours apart, each time it happened about 6 hours after eating (I/D). Each day he appears to be getting better. except for sleeping a liitle more, he has been quite lively. My questions: 1. When I started reading information from your sight on pancreatitis I noticed that some of the dogs seemed pretty sick compared to the symptoms my dog had (fevers, vomiting, other abnormal lab work). Why would my dog be feeling better, but have such a high amylase and no other abnormal labs? I know this is a serious condition, but my vet feels that my dog will be ok. Do you have any thoughts for me? 2. Do you know of anything that helps prevent bladder infections in dogs that have had a history of stones? I read an article that a daily serving of blueberries can help prevent infections in women. My vet said I could try it, but I'm afraid I was not very consistent to see if it worked. 

Answer:

An amylase level in this range is very very likely to indicate pancreatitis and the clinical signs also do fit the disorder. The rise in amylase levels does not correlate directly with the severity of the pancreatitis. Some dogs with relatively mild pancreatitis, which does not last long, have very high amylase levels. Some dogs with severe disease have amylase levels in the normal range. So I would tend to trust your vet's judgment on this one. I did think a little about whether you might have meant that the amylase levels were 1600 and 1300, instead of 16,000 and 13,000. If this were the case, I'd worry about a urinary blockage having lead to the amylase level increase, as this can occur. The amylase levels are elevated over normal (usually the high end of normal is around 880 U/l at most labs) but usually not greater than twice normal. If there was a stone in the ureters or urethra leading to a blockage and it passed, that would explain the pain and the amylase levels, if the values reported are off by an order of 10. I think that you may be thinking of cranberries instead of blueberries. Cranberries cause acidic urine production, which helps to prevent bacteria growth and which inhibits the formation of struvite crystals in the urine. It would be best to avoid foods that acidify the urine while using s/d diet, as it already has this effect and the combination of s/d and a food that acidifies urine may be harmful. Feeding dogs cranberries has not worked all that well for prevention of bladder infections and bladder stones, probably because it is hard to keep the urine acidic all day using these in the diet. Was there an analysis of the stones removed from the urethra last year? Knowing the composition of the stones can be helpful in devising preventative measures. 

High Potassium Levels with Diarrhea

Question:

We have a 14 year old retriever/springer spaniel cross who is dearly loved. For some time now he has been suffering from diarrhoea, but in the last couple of weeks,he has urgently needed to get up 2 or 3 times a night and blood has started to appear in his stools. He has been very thirsty, panting a lot, with no heat rise or exertion.Just before going out he seems to sort of yawn 2 or 3 times, his mouth waters, he swallows a lot and licks his lips.His normal diet is chicken, sprinkled with a mixture of plant extract and minerals called Digestor. We've taken him to the vet who took a blood sample, please see bottom of message for results. His opinion was that the high level of AST , in view of his age and the fact that there were no white cells fighting off infection, was significant and pointed to the likely existence of a pancreatic tumour. If this was the case, then there was nothing we could do, except manage his diet and make him as comfortable as possible. He did not feel a need to take a stool sample. He gave him a shot of antibiotics, and also some vitamins and minerals. We have now changed his diet from chicken to rabbit. In, the last week, his stools have become solid, the blood doesn't seem to be appearing any more, and he hasn't got up in the middle of the night, although he did wet his bed on the first night. We are not sure whether he is rallying, or whether the vet's diagnosis is incorrect. (a) Is a pancreatic tumour the most likely diagnosis, or would the AST level and other readings possibly point to something else ? (b) Is the antibiotic shot significant here ? Is there anything else we can do ? Any suggestions anybody could give would be so much appreciated. The dog belonged to my girlfriend's father, who died last year, so there is a lot of sentimental attachment. 

BLOOD RESULTS

This table, all in normal range

Normal range Result

HCT 37 to 55 42.2% HGB 12 to 18 14.3g/dl MCHC 30 to 36.9 33.9g/dl WBC 6 to 16.9 7.5 x 10 to power 9/L GRANS 3.3 to 12 4.7 x 10 to power 9/L %GRANS 63 NEUT 2.8 to 10.5 3.7 x 10 to power 9/L EOS 0.5 1.5 1.0 x 10 to power 9/L L/M 1.1 6.3 2.8 x 10 to power 9/L %L/M 37 PLT 175 500 348 x 10 to power 9/L

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AST just into high GGT low edge of normal CRE high edge of normal

Na is low K appears to be high, presumably off scale

Normal range

ALB 27 to 38 34g/l ALKP 23 to 212 86U/L ALT 10 to 100 54U/L AMYL 500 to 1500 937U/L AST 0 to 50 53U/L ASPARTATE AMINO TRANSFERAZE UREA 2.50 to 9.64 6.84mmol/l Ca 1.98 to 3.00 2.47mmol/l CHOL 2.84 to 8.27 4.10mmol/l CREA 44 to 159 152umol/l GGT 0 to 7 0 U/L GAMMA GLUTAMYL TRANSFERAZE GLU 4.28 to 6.94 5.66 mmol/l LDH 40 to 400 170U/L LIPA 200 to 1800 1087U/L PHOS 0.81 to 2.19 1.35mmol/l TBIL 0 to 15 4umol/l TP 52 to 82 66 g/l TRIG 0.11 to 1.13 0.75mmol/l GLOB 25 to 45 32g/l Na 144.0 to 160 131.7mmol/l K 3.50 to 5.80 High Cl 109 to 122 112.5mmol/l

BUFFY COTE PROFILE hard to describe !

Answer: 

I am not sure why your vet was worried about a pancreatic tumor, based on the lab work. The most worrisome lab value in this report is the potassium level. Potassium levels above 7 can cause heart problems and can even cause sudden death. I would really want to know if this value had corrected itself, in a patient I was monitoring. High potassium levels are most commonly caused by severe kidney problems and by hypoadrenocorticism. Kidney failure seems unlikely based on the lab work and hypoadrenocorticism that is acquired as dogs age often does not affect the potassium level. Despite this, I would want to know the potassium and sodium levels had returned to normal or run an ACTH response test to rule out hypoadrenocorticism if the potassium remained elevated and the sodium remained low. Administration of saline intravenously helps to reduce the potassium levels and medications are available to control hypoadrenocorticism if it is present. The AST test is not specific enough to be really useful in small animals, but it can indicate liver damage when other liver enzyme levels are elevated, too. In this case, I would have a hard time making a case for liver disease based on the minor elevation of this enzyme with other liver enzymes being normal. GGT has the same problems in dogs (it is more specific for liver disease in cats, though). It would be better to feed a more balanced diet, if possible. I do not think that there is likely to be a link between the diet and the current problems but there may be long term problems with calcium and phosphorous balance with a predominantly meat diet (unless this is a commercial dog food made with rabbit that is a complete nutrient source). I tend to think that a recheck of the lab work will show a return to normal of the abnormal values in the lab work you sent. However, it is important to recheck it. The antibiotic injection may have helped a great deal if there was an infectious problem as the underlying cause of the symptoms seen. There is a good chance that there are other symptoms or physical exam findings that have suggested a more serious problem exists. If your vet continues to feel this way it is often possible to identify pancreatic tumors with ultrasound exam. We send our patients who need ultrasound examination to a specialist in our area. Hope this helps some. 

Reasons for High Cholesterol Levels in Dog Serum

Question:

Can you shed some light on cholesterol levels in dogs? Recent lab results on our 7yr old JR terrier came back with elevated cholesterol levels and it was suggested that we have her thyroid tested. How are these tests done, and what do they mean when they are elevated? What effects do dogs suffer when cholesterol is elevated? As a quick hx, Charlotte is the one with hydrocehpalus and microvasc. liver shunt. She is on Kbr, lasix and prednisone for these conditions, and has done pretty well for close to a year now. Lab results are good except for the cholesterol levels. Thanks for your great service, it is so educational. Maureen

Answer:

High cholesterol levels in dog serum can be associated with drawing the blood too close to a meal, hypothyroidism, Cushing's disease and hyperlipidemia (high fat levels, usually a problem primarily in Schnauzers). Most of the time, high cholesterol levels can be safely ignored in dogs, though. There was a method of detecting hypothyroidism that advocated comparing the total thyroxine level and cholesterol levels and making a ratio from them. If the cholesterol level was over about 350 the ratio always indicated hypothyroidism. There are more accurate ways of assessing thyroid function now. It is hard to argue against thyroid testing when the cholesterol levels are that high, though. Dogs do not typically develop the atherosclerosis seen in humans (except for Dobermans) so there is less risk of higher cholesterol levels in dogs than in humans. In all honesty, I don't know how cholesterol testing actually works so I can't help with that part of the question.